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Ketoacidosis
[[Wikipedia:Ketone bodies|'Ketones']] in the urine, as detected by urine testing stix or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly. Diabetics of all species therefore need to be checked for ketones whenever any of the following signs or triggers are present: * High blood sugar (over 16 mmol/L or 300 mg/dL) * Dehydration (skin doesn't jump back after pulling a bit, gums are tacky or dry) * Low insulin level (no insulin given for some time and subject doesn't make much) * Not eating for over 12 hours due to Inappetance or Fasting * Vomiting * Lethargy * Infection or illness * High stress levels * Breath smells like acetone (nail-polish remover) or fruit. In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus dehydration, are cause to call an emergency vet immediately, at any hour of the day. (These are not the same harmless ketones that Atkins diet users see!) Note that the triggers and signs are somewhat interchangeable because ketoacidosis is, once begun, a set of vicious circles which will make itself worse. So dehydration, hyperglycemia, fasting, and presence of ketones are not only signs, they're also triggers. From the Wikipedia: :Normally, ketone bodies are produced in minuscule quantities, feeding only part of the energy needs of the heart and brain. In DKA, they rapidly become a major component of the brain's fuel. As a result, the bloodstream is filled with an increasing amount of glucose that it cannot use (as the liver continues gluconeogenesis and exporting the glucose so made). This significantly increases its osmolality. :At the same time, massive amounts of ketone bodies are produced, which in addition to increasing the osmolal load of the blood, are acidic. As a result, the pH of the blood begins to change. Glucose begins to spill into the urine as the proteins responsible for reclaiming it from urine reach maximum capacity. As it does so, it takes a great deal of body water with it, resulting in dehydration. Dehydration worsens the increased osmolality of the blood, and forces water out of cells and into the bloodstream in order to keep vital organs perfused. The vicious cycle is now set, and if untreated will lead to coma and death. Trace urinary ketones may or may not be an emergency, depending on the case. If a vet is unavailable, look for some of the other signs or triggers, and try to remedy any you can. Give extra water and food, by syringe if necessary. Continue testing and call a vet when possible. Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down; and force feeding, sometimes by feeding tube. Veterinary care for DKA may involve a hospital stay of five days or more and cost, in the U.S., $2,000 or more. Some animals are DKA prone, and may have multiple episodes of the condition. Veterinarians have sometimes been known to send pets home from a DKA episode while still displaying ketones in the urine -- this is often a fatal mistake. Your chances of fixing the problem yourself are slim. If your cat or dog comes back from the hospital and still has ketones showing on urine testing stix, it's usually best to go right back to the vet's. External links *Wikipedia:Diabetic Ketoacidosis *Emergency veterinary hospitals worldwide *Petdiabetes: Ketoacidosis and Zama's experience *Dr. Elizabeth Hodgkins: Ketones and Low-Carb diet * [http://www.uchsc.edu/misc/diabetes/udchap5.html A chapter about ketone testing from the tenth edition of Understanding Diabetes by H. Peter Chase, MD, a book about living with insulin-dependent diabetic humans] *Treating the Complicated Diabetic Patient--Dr. David Church--WSAVA 2001 * The "hows and whys of ketones" from an FDMB posting Category:ConditionsCategory:EmergenciesCategory:ComplicationsCategory:Vicious circlesCategory:Terms